Application for Renewal ofAssociate Membership
The Hong Kong Society of Paediatric Surgery
Suite 1329, Central Building, 1-3 Pedder Street, Central, Hong Kong
Dear Sir,
I wish to apply for renewal of my current Associate Membership of the Hong Kong Society of Paediatric Surgery.
FULL NAME: English______Chinese______
(Surname first, block letters please)
Sex: M / F Date of Birth (optional): ______Membership Expiry Year:______
ADDRESS: Home ______
______Tel: ______Fax:______
Office______
______Tel: ______Fax:______
You prefer MAILING ADDRESS to be: Home/Office? (Please delete as appropriate)
E-mail address: ______Do you prefer to receive news mainly by e-mail? Yes/No
Date of Application: ______
I enclose a cheque of $100.-
(being $100 for the current year membership fee), payable to “THE HONG KONG SOCIETY OF PAEDIATRIC SURGERY LIMITED”. (Correct amount for current year membership feeby crossed cheque is an essential pre-requisite for application.) Successful members are assured that their data will be disclosed to outsidesocieties only for relevant academic function and the Medical Diary. Please inform Hon. Secretary in writing if you object toreceive thesematerial.
______
(Applicant’s Signature)
*************************
(OFFICIAL USE ONLY)
Passed/declined by Council: Date ______Membership: Ordinary/ Associate
President: ______Hon. Secretary:______Membership No.:______
Fees paid (verified by Hon. Treasurer): ______Applicant Notified: ______
The Hong Kong Society of Paediatric Surgery Guideline for the Use of Personal Data
The Hong Kong Society of Paediatric Surgery (HKSPS) undertakes to comply with the requirements of the PersonalData (Privacy) Ordinance to ensure that personal data kept is accurate and securely kept. To ensure you are well informed of the personal data as collected, please read through this guideline.
Purpose of collection and guideline for use of personal data
1. The HKSPS will use personal data collected from a data subject for the purposes for which it is collected.
2. To provide personal data to the HKSPS is on voluntary basis. However, if you do not provide sufficientpersonal data, we may not be able to process your application or provide service to you.
3. The HKSPS may use your personal data in future (name, telephone number, fax number, email, mailingaddresses) for the purposes of providing you with information of the Society, handling application,issuing receipt, research, fundraising appeal, collecting feedbacks, as well as activities invitation andrelated promotion purposes.
Access to and updating personal data, request for cessation of using personal data for promotion purposes
Apart from the exemptions provided under the Personal Data (Privacy) Ordinance, you are entitled toaccess and update your personal data held by the HKSPS, and request us to ceaseto use your personal data for promotion purposes.
If you object the HKSPS to use your personal data for the purposes as stated above, please contact us inwritten with your full name, telephone number as well as date by mail / fax / email. No charge will beapplied.
Name: The Hong Kong Society of Paediatric Surgery
Address: Suite 1329, Central Building, 1-3 Pedder Street, Central, Hong Kong
Fax: (852) 28696916
Email: